Corticosteroids drugs uses

Stopping corticosteroid therapy
In autoimmune disease, clear end-points should be set before starting therapy. Corticosteroids may improve mood and give patients a feeling of general well-being unrelated to the effect on the disease being treated. Subjective assessments can therefore be misleading. Objective clinical parameters should be used to monitor the need for continuing or restarting therapy . proteinuria in nephritis, spirometry in asthma and creatinine kinase in myositis. Therapy should be tapered off. For example, with prednis(ol)one, the dose is reduced in steps of -5 mg every 3-7 days down to 15 mg/day. At that point, switch to alternate day therapy and reduce in mg steps over 2-3 weeks. This minimises the impact on mood and lessens the drop in general well-being.

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An example of an acute hepatitis-like syndrome arising after pulse methylprednisolone therapy.  These episodes arise typically 2 to 4 weeks after a third or fourth cycle of pulse therapy, and range in severity from an asymptomatic and transient rise in serum aminotransferase levels to an acute hepatitis and even fulminant hepatic failure.  In this instance, the marked and persistent rise in serum enzymes coupled with liver histology suggesting chronic hepatitis led to a diagnosis of new-onset autoimmune hepatitis, despite the absence of serum autoantibodies or hypergammaglobulinemia.  Autoimmune hepatitis may initially present in this fashion, without the typical pattern of serum autoantibodies during the early, anicteric phase.  The diagnosis was further supported by the prompt improvements in serum enzymes with prednisone therapy.  The acute hepatitis-like syndrome that can occur after pulses of methylprednisolone is best explained as a triggering of an underlying chronic autoimmune hepatitis caused by the sudden and profound immunosuppression followed by rapid withdrawal.  This syndrome can be severe, and fatal instances have been reported.  Whether reinitiation of corticosteroid therapy with gradual tapering and withdrawal is effective in ameliorating the course of illness is unclear, but anecdotal reports such as this one suggest that they are beneficial and should be initiated promptly on appearance of this syndrome.  Long term follow up of such cases is also necessary to document that the autoimmune hepatitis does not relapse once corticosteroids are withdrawn again.

References
1. Interspecies differences in renal localization of cyclooxygenase isoforms: Implications in nonsteroidal anti-inflammatory drug-related nephrotoxicity. Khan KN, Venturini CM, Bunch RT, et al. Toxicol Pathol 26:612-620, 1998.
2. Gastric hemorrhage in dogs given high doses of methylprednisolone sodium succinate. Rohrer CR, Hill RC, Fischer A, et al. Am J Vet Res 60:977-981, 1999.
3. Efficacy of misoprostol in prevention of gastric hemorrhage in dogs treated with high doses of methylprednisolone sodium succinate. Rohrer CR, Hill RC, Fischer A, et al. Am J Vet Res 60:982-985, 1999.
4. Clinical evaluation of cimetidine, sucralfate, and misoprostol for prevention of gastrointestinal tract bleeding in dogs undergoing spinal surgery. Hanson SM, Bostwick DR, Twedt DC, et al. Am J Vet Res 58:1320-1323, 1997.
5. Effects of prednisone alone or prednisone with ultralow-dose aspirin on the gastroduodenal mucosa of healthy dogs. Graham AH, Leib MS. J Vet Intern Med 23:482-487, 2009.
6. Prostaglandins, NSAIDs, and gastric mucosal protection: Why doesn’t the stomach digest itself? Wallace JL. Physiol Rev 88:1547-1565, 2008.
7. Spontaneous gastroduodenal perforation in 16 dogs and seven cats (1982-1999). Hinton LE, McLoughlin MA, Johnson SE, et al. JAAHA 38:176-187, 2002.
8. Gastrointestinal tract perforation in dogs treated with a selective cyclooxygenase-2 inhibitor: 29 cases (2002-2003). Lascelles BD, Blikslager AT, Fox SM, et al. JAVMA 227:1112-1117, 2005.
9. The interaction between orally administered non-steroidal anti-inflammatory drugs and prednisolone in healthy dogs. Narita T, Sato R, Motoishi K, et al. J Vet Med Sci 69:353-363, 2007.
10. Effects of flunixin and flunixin plus prednisone on the gastrointestinal tract of dogs. Dow SW, Rosychuk RA, McChesney AE, et al. Am J Vet Res 51:1131-1138, 1990.
11. Effects of ranitidine, famotidine, pantoprazole, and omeprazole on intragastric pH in dogs. Bersenas AM, Mathews KA, Allen DG, et al. Am J Vet Res 66:425-431, 2005.
12. The effect of dosing interval on the efficacy of misoprostol in the prevention of aspirin-induced gastric injury. Ward DM, Leib MS, Johnston SA, et al. J Vet Intern Med 17:282-290, 2003.
13. Gastric mucosal lesions in dogs with acute intervertebral disc disease: Characterization and effects of omeprazole or misoprostol. Neiger R, Gaschen F, Jaggy A. J Vet Intern Med 14:33-36, 2000.
14. Endoscopy of the gastroduodenal mucosa after carprofen, meloxicam and ketoprofen administration in dogs. Forsyth SF, Guilford WG, Haslett SJ, et al. J Small Anim Pract 39:421-424, 1998.
15. Management of NSAID-induced gastrointestinal toxicity: Focus on proton pump inhibitors. Lazzaroni M, Porro GB. Drugs 69:51-69, 2009.

Corticosteroids drugs uses

corticosteroids drugs uses

References
1. Interspecies differences in renal localization of cyclooxygenase isoforms: Implications in nonsteroidal anti-inflammatory drug-related nephrotoxicity. Khan KN, Venturini CM, Bunch RT, et al. Toxicol Pathol 26:612-620, 1998.
2. Gastric hemorrhage in dogs given high doses of methylprednisolone sodium succinate. Rohrer CR, Hill RC, Fischer A, et al. Am J Vet Res 60:977-981, 1999.
3. Efficacy of misoprostol in prevention of gastric hemorrhage in dogs treated with high doses of methylprednisolone sodium succinate. Rohrer CR, Hill RC, Fischer A, et al. Am J Vet Res 60:982-985, 1999.
4. Clinical evaluation of cimetidine, sucralfate, and misoprostol for prevention of gastrointestinal tract bleeding in dogs undergoing spinal surgery. Hanson SM, Bostwick DR, Twedt DC, et al. Am J Vet Res 58:1320-1323, 1997.
5. Effects of prednisone alone or prednisone with ultralow-dose aspirin on the gastroduodenal mucosa of healthy dogs. Graham AH, Leib MS. J Vet Intern Med 23:482-487, 2009.
6. Prostaglandins, NSAIDs, and gastric mucosal protection: Why doesn’t the stomach digest itself? Wallace JL. Physiol Rev 88:1547-1565, 2008.
7. Spontaneous gastroduodenal perforation in 16 dogs and seven cats (1982-1999). Hinton LE, McLoughlin MA, Johnson SE, et al. JAAHA 38:176-187, 2002.
8. Gastrointestinal tract perforation in dogs treated with a selective cyclooxygenase-2 inhibitor: 29 cases (2002-2003). Lascelles BD, Blikslager AT, Fox SM, et al. JAVMA 227:1112-1117, 2005.
9. The interaction between orally administered non-steroidal anti-inflammatory drugs and prednisolone in healthy dogs. Narita T, Sato R, Motoishi K, et al. J Vet Med Sci 69:353-363, 2007.
10. Effects of flunixin and flunixin plus prednisone on the gastrointestinal tract of dogs. Dow SW, Rosychuk RA, McChesney AE, et al. Am J Vet Res 51:1131-1138, 1990.
11. Effects of ranitidine, famotidine, pantoprazole, and omeprazole on intragastric pH in dogs. Bersenas AM, Mathews KA, Allen DG, et al. Am J Vet Res 66:425-431, 2005.
12. The effect of dosing interval on the efficacy of misoprostol in the prevention of aspirin-induced gastric injury. Ward DM, Leib MS, Johnston SA, et al. J Vet Intern Med 17:282-290, 2003.
13. Gastric mucosal lesions in dogs with acute intervertebral disc disease: Characterization and effects of omeprazole or misoprostol. Neiger R, Gaschen F, Jaggy A. J Vet Intern Med 14:33-36, 2000.
14. Endoscopy of the gastroduodenal mucosa after carprofen, meloxicam and ketoprofen administration in dogs. Forsyth SF, Guilford WG, Haslett SJ, et al. J Small Anim Pract 39:421-424, 1998.
15. Management of NSAID-induced gastrointestinal toxicity: Focus on proton pump inhibitors. Lazzaroni M, Porro GB. Drugs 69:51-69, 2009.

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